Serration pattern analysis as a practical adjunct tool for categorization of subepidermal autoimmune blistering diseases

Arora, Sukriti and Shetty, Varsha M and Rao, Chythra R and Pai, Satish B and Rao, Raghavendra (2021) Serration pattern analysis as a practical adjunct tool for categorization of subepidermal autoimmune blistering diseases. Indian journal of dermatology, venereology and leprology, 87 (6). pp. 778-786. ISSN 0378-6323

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Abstract

Background: Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely,it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center.Objectives: The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders. Methods: Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. Athree millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings. Results: Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed “n” serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an “n” serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a “u” serrated pattern. Three patients with negative indirect immunofluorescence showed “u” serration on direct immunofluorescence while the rest showed “n” serration.Limitations: ELISA and immunoblotting could not be performed due to resource constraints.Conclusion: Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable

Item Type: Article
Uncontrolled Keywords: Serration pattern; Immunofluorescence; Subepidermal autoimmune blistering disorders
Subjects: Medicine > KMC Manipal > Community Medicine
Medicine > KMC Manipal > Dermatology
Depositing User: KMC Library
Date Deposited: 28 Jan 2022 04:21
Last Modified: 28 Jan 2022 04:21
URI: http://eprints.manipal.edu/id/eprint/158053

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